Provider Demographics
NPI:1275849093
Name:SWEET, SHANNON L (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:SWEET
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:L
Other - Last Name:SAVAGE-SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2031
Mailing Address - Country:US
Mailing Address - Phone:979-229-1175
Mailing Address - Fax:
Practice Address - Street 1:2700 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2031
Practice Address - Country:US
Practice Address - Phone:979-229-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604376163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant